In the operatory where I work hangs a sign that reads “Welcome Home.” It hangs among a wall of photos — most of them black and white — of men and women dressed in uniform (some more casually), standing on warships or next to aircrafts. I work as a general dentist at the outpatient Veterans Affairs (VA) dental clinic in Chico, California. Many of my patients like to add their photos from their time of service to our decorated wall. For them, sharing photos is their way of sharing their stories.
Chico is a small town with a large population of veterans, many of whom served in the Vietnam War (1955-1975). I treat a special group of veterans who are eligible through the VA to receive free dental care. Their eligibility is determined by a percentage rating from zero to 100 assigned for each illness or injury sustained during military service, such as ischemic heart disease resulting from Agent Orange exposure or Post-Traumatic Stress Disorder (PTSD). There are some exceptions to this rule, and not all veterans with service-connected disabilities qualify for VA dental care. From speaking with some of my patients, the eligibility determination can be a long and complicated process, especially since the rating is not permanent and may change depending on the type of medical disability or other factors. For some, it may be decades until they are dental eligible.
One morning, at the end of a routine filling appointment, one of my patients told me that he had waited 30 years since starting his military service to get his fillings done. He remembers joining the military and dreaming of the day when he could get his front tooth fixed. This patient is 62 years old and only recently received his full eligibility for VA dental care as a result of being 100 percent service-connected for PTSD.
I see the effects of PTSD on dentition nearly every day. It can appear as generalized attrition from bruxism or rampant caries from neglect or drug abuse. PTSD is a growing epidemic, afflicting almost 31 percent of Vietnam veterans, 10 percent of Gulf War veterans, 11 percent of veterans of the war in Afghanistan and 20 percent of Iraqi war veterans, according to the Department of Veterans Affairs. By learning more about the signs of PTSD and treatments available, we can improve the quality of life of those afflicted.
Another one of my patients with PTSD presented to me with rampant caries and multiple teeth with poor-to-questionable prognosis, something that I would typically treat with a prescription of Colgate 5000ppm fluoride toothpaste and Periogard rinse. While listening to me go over his dental prognosis and prescription, the patient suddenly became agitated and exclaimed, “It was never my choice to go to war! I never signed up!” It was at this moment I realized that my discussion of his poor dentition had probably triggered some longtime resentment for being drafted into a war that he didn’t want to fight, and ultimately enduring debilitating physical injuries and psychological trauma as a result.
I continue to reflect on the sacrifices our military men and women have had to face, risking their lives for our freedom. They deserve our utmost respect, as well as the best medical and dental care out there.
My goal is to make each veteran who comes to our office feel safe, comfortable and respected. Serving the veterans every day feels more like a privilege than a job. I behold a precious responsibility to care for our country’s war heroes, many of whom are medically compromised.
Ironically, these same service-connected disabilities that qualify for dental eligibility may also become a barrier to dental care. Some veterans have medical conditions that are so critical that they are unable to safely undergo dental treatment or even transport to a dental clinic. To make matters worse, many of these veterans lost their homes in the recent devastating wildfires of Paradise, Concow and Oroville (neighboring towns of Chico). Now more than ever, it has become imperative to provide a warm and inviting dental home for them — a place where they can share their stories and count on a familiar friendly face.
~Tiffany Hsu, DDS
ASDA’s National Outreach Initiative (NOI) is currently focused on the unique needs of the veterans population. Launched in summer 2017, the NOI promotes community outreach and raises awareness about the special considerations in caring for underserved populations. From June 2018 to August 2018, the NOI focused on geriatric and elderly patients and displaced populations (including the homeless, refugees, migrant workers and natural disaster survivors) from September 2018 to November 2018. The veterans population is being featured from December 2018 to February 2019. New this year, FlashGuides were created for each special population focus to aid discussion and event planning.
ASDA thanks Colgate for their exclusive sponsorship of the National Outreach Initiative. This backing includes funding for the Dentistry in the Community Grant and free oral health care supplies to any chapter that requests them.